| Doctor Name: | KRISTEN NICHOLS |
| NPI Number: | 1043529886 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | MS, QMHP, CADC |
| License Number: | |
| Business Practice Address: | 325 Il Route 2 Dixon, IL - 610219118 |
| Business Phone Number: | 8152846611 |
| Business Fax Number: | |
| Mailing Address: | 325 Il Route 2, DIXON |
| State: | IL |
| Postal Code: | 610219118 |
| Phone Number: | 8152846611 |
| Fax Number: | |
| NPI Enumeration Date: | 09/28/2010 |
| NPI Last Update Date: | 03/20/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YM0800X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | IL |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Mental Health |
| Taxonomy Definition: | |